Forging long-term care and home health partnerships

Operating senior living communities can have its challenges. Ensuring the highest-quality care is paramount and at the top of the list. One creative and unique way to ensure outstanding quality is to develop key strategic partnerships with all the community resources at your disposal. For senior living communities, this means putting a special focus on those relationships with home care, personal care and hospice companies, by using each other’s services and leveraging those relationships for optimum care and value.

To create better understanding and a common language, let me explain that my use of “home care” refers to skilled Medicare companies that provide intermediate home care services such as nursing, physical therapy and occupational therapy. “Personal care” refers to nonmedical companies that provide companion, personal care and complex personal care services and are usually private pay. “Hospices” are those companies that provide palliative and end-of-life care services paid for by Medicare or insurance companies.

If a nursing home or assisted living community doesn’t create and maintain these partnerships with home care, personal care and hospice companies, then they are severely disadvantaged when working with hospitals. From the hospital’s perspective, without these vital partnerships, quality outcomes are lost and unnecessary and inappropriate readmissions increase. If your community cannot overcome these stipulations, then you potentially could lose referrals as well as the ability to participate in accountable care organizations.

In addition, strong partnerships enable your organization to help people age in a place, which advances both your mission and business objectives. Most senior communities’ economic engines are fueled by keeping a strong facility census. “Closing the back door” is critical to maintaining and building a strong census and creating a strong relationship with home care, personal care and hospice. All of these functions can assist you in your efforts to differentiate your community in an increasingly competitive marketplace, and having the ability to offer home care and palliative medicine services will help to promote your organization through referral sources and to the community-at-large.

The value proposition matrix below will help you identify those companies that will bring you the most value and be good partners. A senior living community with skilled nursing and assisted living can effectively go about developing several strategic partnerships using this matrix and using it as a checklist.


A senior living community with skilled nursing and assisted living components developed several strategic partnerships. First, however, it had to correct one big problem: Too many cooks in the kitchen.

This senior community had nine hospices, 10 homecare companies and eight personal care home health companies all vying for the same referrals. The variances in the services delivered were all over the map, as was the ability to get and manage reliable data. Several processes were put in place to help this senior living community improve its operations.


The first thing the executive director in this community did was make all these companies aware he was going to select three providers in each category. It was a bold move, but it worked. He went through a mini RFP (request for proposal) process using the value proposition matrix to select his team.

If someone who came to the facility already was working with another provider, the executive director continued to allow that provider to work in his building. Referrals from within the building, however, went to one of the pre-approved team facilities. This process set a precedent for better team work, data-sharing, use of electronic helath records and overall outcomes.


When the team members could do so, they looked for opportunities to avoid an emergency department (ED) visits and, as appropriate, sent patients/residents directly to one of the team members. Home care, personal care and hospice companies worked creatively to keep people safe and secure in the home setting.

If someone went to the ED, the team worked diligently to send him or her right back to his or her care setting, allowing that company to better manage the care. If the patient/resident was a fall risk, then a personal care referral was made. If the patient/resident met hospice eligibility guidelines, then the appropriate referral was made.

Continuous process improvement initiatives exist related to ED transfers inside the post-acute setting (the team). Using this approach, this senior community learned to master congestive heart failure, pneumonia and myocardial infarction. Now this facility is better prepared for the next set of penalized diagnosis-related groups.


One of the three hospice team members worked with the senior community to develop a general inpatient hospice program (GIP) cluster bed program. This was an excellent development of a program element that greatly improved the community’s ability to reduce readmissions and create a new revenue stream.

This was accomplished by turning two beds at the end of a wing into palliative care suites. Those who met GIP criteria were cared for in one of these palliative care suites to treat and get their breakthrough pain or out-of-control symptoms managed. This helped make a discharge to home more simple.

Instead of going to the hospital, those discharged to home who developed GIP-related issues could be admitted to the palliative care suite for care. All appropriate care was handled by the team, and the facility was reimbursed $375 per day from the hospice for the use of the bed and facility’s services. The GIP level of care is allowed and encouraged by the Centers for Medicare & Medicaid Services (CMS). Ultimately, this provided the community the ability to generate $260,000 in one year from the hospice providing GIP care, in addition to driving better outcomes.


One of the final steps was data tracking. The senior community monitored the team members as well as physicians’ data and compliance through benchmarking. It started to share the data with hospitals, which resulted in the facility becoming part of a hospital’s post-acute provider networks. This benefited all the members of the team, allowed the facility to customize its data and provided more information than often is requested to help create a clear picture of the efforts and results.


The senior community took advantage of what the home care and hospice CMS conditions of participation allowed and from that built its delivery model and service mix. The best example of this is how the senior community and the hospice company entered in a GIP contract and then used that contract to develop a GIP cluster bed/palliative care suite program.

The partnership with the personal care company was creatively used in several ways. One example: A small office space was given to the three personal care companies that rotated its use, so that a caregiver was on the campus seven days a week, 10 hours per day. The personal care company paid for this staffing and, in part, the caregiver would provide many services, such as helping with discharges to home, assisting with transportation home (if needed) and providing three hours of “tuck-in” service at home. This safe discharge home program was paid for either by the family or the facility.

Although this is one study, the results prove that when applied correctly, a senior community can create longstanding and worthwhile partnerships with home care, personal care and hospice companies. The opportunities to work with not only these three types of organizations, but other community resources, too, will help senior living communities be stronger and more financially viable companies.

Kurt A. Kazanowski, MS, RN, CHE, has 30 years of experience as a healthcare executive. He works with senior living communities, hospices, home care companies and hospitals to assist them in serving more people, increasing market share and strengthening profitability. For more information, visit or

Topics: Articles , Executive Leadership , Facility management , Finance , Leadership , Risk Management , Staffing